Family Medicine最新文献

Background and objectives: Building on research highlighting the success of tribal, rural, and underserved clerkships to increase students' intention to practice family medicine in these areas, we explored the perspectives of prospective precepting physicians and administrators to develop an optimal structure to facilitate recruitment of external preceptors.

Methods: We conducted semistructured interviews with family physicians (N=14) and health system administrators (N=14) working in tribal, rural, and underserved areas. Discussions were recorded, transcribed verbatim, and coded independently by two researchers. Applying rapid assessment qualitative research methods, we used a framework method to identify emergent themes that were applied to improve the recruitment of external preceptors.

Results: Physicians identified key facilitating factors and barriers to serving as a preceptor, which paralleled those common within the existing literature. However, administrators were motivated to serve as a precepting site to increase the potential of recruiting future physicians. We developed the Premier Medical Education Hub model to align these different but compatible interests with the goal to increase preceptor participation. In this model, each host site dedicates staff and adopts standardized procedures to manage rotations, hosts at least five students annually, provides housing, has procedures to facilitate electronic health record access, and offers student immersion experiences.

Conclusions: As practice ownership shifts from physician-owned to health system ownership, administrators become the gatekeepers for prospective preceptors. Our findings demonstrate that integrating the compatible interests between physicians and administrators allows for the creation of a synergistic model that facilitates preceptor recruitment.

Background and objectives: Increasing diversity among medical educators is a vital step toward diversifying the physician workforce. This study examined how gender, race, and other attributes affect family medicine department chairs' experiences with sponsoring, mentoring, and coaching (SMC). We identified strategies at multiple levels to enhance SMC for faculty from underrepresented groups (URGs).

Methods: Our qualitative study employed semistructured interviews with the chairs of departments of family medicine in the United States. We used inductive and deductive thematic analysis approaches to describe the experience and name usable strategies organized along the social-ecological model.

Results: We interviewed 20 family medicine department chairs between December 2020 and May 2021. Many participants continued to be alarmed that leaders and role models from URGs have been rare. Participants described incidents of aggression in White- and male-dominated atmospheres. Such experiences left some feeling not at home. Some White male leaders appeared oblivious to the experiences of URG faculty, many of whom were burdened with a minority tax. For some URGs, surviving meant moving to a more supportive institution. Building spaces for resiliency and connecting with others to combat discrimination gave meaning to some participants. Participant responses helped identify multilevel strategies for empowerment and support for URG faculty.

Conclusions: Understanding the experiences of URG faculty is paramount to improving the environment in academic medicine-paving the way to enhancing diversity in the health care sector. Institutions and individuals need to develop multilevel strategies for empowerment and support to actively make diverse faculty feel at home.

Background and objectives: Assessing suicide risk in primary care settings has become standard practice; however, the emotional toll on medical providers remains understudied. This qualitative study examines the emotional impact of suicide assessments among family medicine residents.

Methods: We conducted one-on-one, semistructured, in-depth interviews with a convenience sample of residents enrolled in a family medicine residency program at a US military installation. Employing an exploratory, qualitative research approach, we iteratively coded transcribed interviews for content and themes.

Results: For this study, we interviewed 15 family medicine residents spanning all three postgraduate year groups. The primary objective of the comprehensive study was to evaluate the confidence levels of family medicine residents in suicide risk screening, with the intent to identify educational gaps for improvement. However, unexpectedly, participants revealed their profound negative emotional responses during these assessments. The emotional impact of suicide risk assessment was the most frequently coded theme in the study, with participants noting six main emotional reactions to assessing suicide risk among their patients: fear, weariness, anxiety, shock, overwhelm, and inadequacy.

Conclusions: Despite claims of emotional detachment, participants often expressed surprise and vulnerability when faced with suicidal patients. With suicide screening becoming increasingly vital in primary care, understanding and mitigating the emotional impact on physicians is essential. Future research should explore strategies to support medical providers in navigating these challenging interactions effectively for both the patients and themselves.

Background and objectives: Recognition of the need for medical education to train physicians who are skilled at supporting population health and work beyond traditional health care settings is growing. Entrustable professional activities (EPAs) for medical students typically have centered around activities taking place in the clinical workplace; however, EPAs that involve working with community members in community contexts have not been clearly established.

Methods: We used a three-stage online modified-Delphi method to identify community-based EPAs for University of Wisconsin School of Medicine and Public Health medical students. We recruited key stakeholders to participate and asked them, based on their experience, to generate a list of community-based tasks that they believed graduates should be trusted to perform. Subsequently, using a five-point anchored Likert scale (1=strongly disagree to 5=strongly agree), we asked participants to rate their level of agreement with each identified task becoming an EPA. An a priori definition of consensus was established.

Results: Twenty-two tasks reached consensus as potential community-based EPAs. The tasks with the highest mean ratings were "addressing trust issues with the medical community amongst the local population" (mean=4.71), "meeting with community members around a health topic" (mean=4.64), "identifying opportunities for disease prevention" (mean=4.64), and "identifying policies that impact community outcomes" (mean=4.57).

Conclusions: The identified community-based tasks can support the augmentation of existing community-based curriculum and help identify areas for novel curriculum and assessment development. Lessons learned from this local effort could be helpful to other programs seeking to establish and refine community-based curricula.

Introduction: Reports on the effects of changing the United States Medical Licensing Exam (USMLE) Step 1 examination scoring to pass/fail are evolving in the medical literature. This Council of Academic Family Medicine Educational Research Alliance family medicine clerkship directors' study seeks to describe family medicine clerkship directors' perceptions on the impact of incorporation of Step 1 pass/fail score reporting on students' family medicine clerkship performance.

Methods: Ninety-six clerkship directors responded (56.8% response rate). After exclusion of Canadian schools, we analyzed 88 clerkship directors' responses from US schools. We used descriptive statistics for demographics and responses to survey questions. We used ꭓ2 analysis to determine statistically significant associations between survey items.

Results: Clerkship directors did not observe changes in students' overall clinical performance after Step 1 pass/fail scoring (60.8%). Fifty percent of clerkship directors reported changes in Step 1 timing recommendations in the past 3 years. Reasons included curriculum redesign (30.5%), COVID (4.5%), change in Step 1 to pass/fail (11.0%), and other reasons (3.7%). Forty-five percent of these clerkship directors did not observe a change in students' clinical medical knowledge after Step 1 went to pass/fail. Eighty-four percent of these clerkship directors did not compare student performance on clerkship standardized exams before and after Step 1 score changes. We found no significant relationship between Step 1 timing and student performance.

Conclusions: This study represents an early description of family medicine clerkship directors' perceived observations of the impact of Step 1 scoring changes on student performance. Continued investigation of the effects of USMLE Step 1 pass/fail scoring should occur.

Background and objectives: Despite increasing numbers of faculty identifying as underrepresented in medicine (URiM) over the last few decades, URiM representation in academic medicine leadership has changed little. The Society of Teachers of Family Medicine funded the Leadership Through Scholarship Fellowship (LTSF) to target this population and provide a framework for scholarly success. Based on responses to open-ended questions from a leadership survey, we characterize how early-career URiM family medicine faculty view leadership and assess attitudes and perceptions of leadership development.

Methods: A survey, developed by survey experts from multiple institutions and consisting of multiple-choice and open-ended questions, was sent to the first two cohorts after the LTSF program. All LTSF participants identified as URiM and as early-career (5 years or less since fellowship or residency) family medicine faculty. Fellowship faculty collected anonymous survey responses through Qualtrics (Qualtrics, LLC). We conducted thematic analysis with emergent and iterative coding by two experienced qualitative researchers.

Results: All of the fellows surveyed (N=19) completed the survey. The qualitative researchers identified the following themes: leadership development (with subthemes of collaborative scholarship and request for mentoring), and barriers to leadership and scholarship (with subthemes of lack of time, lack of support, and diminished opportunities for advancement).

Conclusions: These themes represent lessons learned from URiM faculty participating in a single faculty development fellowship. Collaborative scholarship, both as an early-career faculty need and a leadership responsibility, is a new contribution to the existing literature. While identified by URiM family medicine faculty, these themes are likely familiar to early-career faculty across all medical specialties and faculty identities. These lessons can guide senior academic leaders in preparing early-career faculty for leadership in academic medicine.